Unintended Pregnancy with Implantable Subdermal Contraceptive Device (Nexplanon): A Case Report

Abstract

Background: In 2006, Implanon (68 mg), a synthetic subcutaneous progestin etonogestrel eluting capsule, was approved for use in the U.S. to provide longacting reversible contraception (LARC). The next generation LARC, Nexplanon (68 mg), a progestin-only etonogestrel subdermal implant, was available in 2001. Currently, Nexplanon is advertised to provide 99% effective contraception, up to 4 years. Removal of the capsule will revert back to normal menstruation and fertility. Unlike Implanon, cases of unintended uterine pregnancy with proper and successful insertion have not been reported using Nexplanon. Case:A 24-year-old female, G2P1001, with obstetrical history of one spontaneous vaginal delivery (2015), and gynecological history of low grade squamous intraepithelial lesion (LSIL) on Pap smear (2014), was found to have an intrauterine pregnancy while using Nexplanon. Initially, urine pregnancy testing assured that she was not pregnant before placement of the Nexplanon. Nexplanon was inserted ~2 months post-partum after the birth of her first child.17 months post-Nexplanon insertion, patient experienced irregular spotting, cramping, and reported positive home pregnancy test. Transvaginal ultrasound confirmed an intrauterine pregnancy at 9 weeks and 3 days. The Nexplanon implant was removed intact. Routine prenatal care was initiated and no issues were identified. Conclusion:Newer LARCs provide an alternative to lifestyle adaptive contraception, with ease of use and compliance. Although LARCs prove to be more effective, known factors linked to human error during placement, cytochrome P450 induction, and BMI, have shown to decrease their efficacy, leading to failed contraception. be associated with an unintended uterine pregnancy with proper and successful insertion. Keywords:Contraindications for the implant include; known or suspected pregnancy, current or past history of thrombosis or thromboembolic disorders, liver tumors (benign or malignant), active liver disease, undiagnosed abnormal genital bleeding, known or suspected breast cancer, personal history of breast cancer, other progestin-sensitive cancer and allergies to the components of Nexplanon [12,13]. Side effects of Nexplanon include; irregular menses, headache, vaginitis, breast pain, weight gain, acne, abdominal pain, and pharyngitis [12,13]. Although Nexplanon is used to prevent pregnancy, if the implant fails, there is an increased risk for ectopic pregnancy [12]. We present the first case of intrauterine pregnancy while using Nexplanon [14]. Case ReportThis patient is a 24-year-old female, G2P1001, with past medical history of asthma controlled with albuterol, asthmatic bronchitis treated with amoxicillin, and iron deficiency anemia was found to have an intrauterine pregnancy while using Nexplanon. Obstetrical history is significant for one spontaneous vaginal delivery in 2015, and gynecological history includes low grade squamous intraepithelial lesion (LSIL) on pap smear in 2014, with no further abnormal pap smears. She had used Nexplanon ...